Hormonal Reassessment of Iraqi Hirsute Women Searching For Sources of Hyperandrogenism

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Author(s) Mohammed Abdul-Mounther | Fadhil Abas Abdul AL-Rassol | Wissam Majeed Katof
Pages 250-258
Volume 5
Issue 6
Date June, 2016
Keywords Hirsutism,Hyperandrogenism,Hormonal Reassessment
Abstract

Hirsutism is an excess of terminal hair growth in women in a pattern more typical of men. Terminal hair growth in a male pattern is undoubtedly due to the effect to androgens, and reflects the conversion of vellus hair to terminal hair follicles .Androgens are produced by the adrenals and ovaries. The four primary circulating androgenic steroids in women are dehydroepiandrosterone (DHEA) and its sulphate (DHEA-S), androstenedione and testosterone. The objective of this study is to reassess the hormonal status of Iraqi hirsute women searching mainly for sources of hyperandrogenism. In this cross-sectional study, 98 Iraqi hirsute females patients aged between 14 and 55 years, and aged matched with 50 Iraqi females (the control),who referred themselves to the Dermatology Clinic of AL-Saddar teaching hospital and two private dermatology clinics between February2013 and December 2014, were investigated. A personal history was obtained from each patient. Body mass index (BMI; weight/height2) was also measured. A trans abdominal ultrasonography and hormonal profile was conducted for all patients with hirsutism regardless of the degree of hirsutism or regularity of menses.The degree of hirsutism was assessed according to the Ferriman-Gallwey score. Fifty-three patients had a score of more than 7 (54%), 41 of them had a score of more than 10 (41.8%), and only 4patients presented with a score of more than25 (4%). Overall, 58 patients(59.1%) had a positive family history of hirsutism. The hormonal workup revealed that the total serum level of testosterone was elevated in 30 patients (33.7%), while the serum level of free testosterone was elevated in 55 patients (56.1%). Sex hormone-binding globulin as the main transporter for androgens was significantly decreased in 25 patients (25.5%).The dehydroepiandrosterone sulphate (DHEA-S) serum level was elevated in 24 patients (24.4%). The insulin level was above the normal range in only 6 patients (6.1%) and all of them had PCOS. Hyperprolactinemia was present in 37 patients (37.7%). An abnormal lipids profile was seen in 79 women(80.6%),all of whom either overweight or obese.Nearly all of the Iraqi hirsute premenopausal women had an abnormal hormonal profile. The sources of hyperandrogenism were PCOS in one third of patients, followed by an adrenal source in a quarter of them as a mild elevation in DHEA-S. Another important source was the low level of SHBG, while idiopathicity did not register as a factor, according to this study. Good advice regarding the results of the lipids profiles and body mass index measurements for all hirsute women is to lose weight.

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